Provider Demographics
NPI:1942643010
Name:VANBOMEL, DANIEL A (LMHC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:VANBOMEL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 MCCORMICK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1046
Mailing Address - Country:US
Mailing Address - Phone:813-317-0110
Mailing Address - Fax:
Practice Address - Street 1:2623 MCCORMICK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1046
Practice Address - Country:US
Practice Address - Phone:813-317-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health